Literacy, health literacy and the association with health behaviours

Abstract

Background
Socioeconomic status is directly related to health in the UK. People from non-skilled households are twice as likely to smoke, drink excessively, have a poor diet and insufficient activity levels compared to those in professional households. Those in lower socioeconomic groups tend to have lower literacy levels and lower educational achievement. Poor health literacy has been associated with adverse health outcomes and higher mortality, it is also hypothesised that literacy may have a role in health behaviours. This project explores the association between literacy and health behaviours.

Methods
A systematic review was conducted in October 2013 and updated in January 2015 to examine the association between literacy and health behaviours. Online electronic databases were search, key papers were reference checked and experts in the field were contacted for additional literature.
A secondary analysis was conducted on the Healthy Foundations data set, a large (n=4928), cross-sectional study. Unadjusted associations between educational achievement and individual health behaviours were initially explored using multinomial logistic regression; then analysed adjusting for age, gender, indices of multiple deprivation, national statistic socio-economic classification and ethnicity.

Results
The systematic review identified a total of 39 papers, papers were not excluded on quality. Overall the systematic review demonstrated inconsistent evidence exploring the association between literacy and diet, exercise, alcohol consumption, and smoking. The review highlighted insufficient evidence for drug use and condom use.
The analysis of the cross-sectional dataset demonstrated an association between low educational achievement and smoking, not doing any exercise, eating little or no fruit and vegetables, more risky sexual practices (not using condoms when at risk) and not drinking alcohol. A non-significant relationship was found between education and drug use.

Conclusion
Lower education is associated with smoking, not exercising, eating less fruit and vegetables and not using condoms; however more research is needed to strengthen this conclusion. There is inconsistent evidence when considering the associations between literacy, when investigated with objective tools, and health behaviours so further research in this area is recommended.